Leadership: The Prerequisite to Prosperity
The responsibility of creating dental offices able to quickly adapt to the fast pace of change lies solely with those in leadership roles. More often than not, this is the doctor. However, in highly developed, team-centered offices, it will also be the team members. Their success depends on their ability to empower their people and to have them take responsibility, or ownership, of the practice’s objectives.
According to John Naisbitt, author of Megatrends 2000, leadership in the coming years will move toward decentralization with more decisions being made at the lowest possible level. Consequently, the classical command and control type of management style will be thrown out.
Traditional dentists tend to focus more on “hard” issues such as: 1) quality, 2) service, 3) profitability, 4) cost control, and 5) productivity. These issues most often take the form of declining profits, productivity declines or plateaus, unacceptable patient service and personnel problems. In reality these issues are only symptoms of the real underlying issues. Dentists tend to focus on hard issues because they are easy to see, recognize, measure and, in some ways, they seem easy to address.
In most cases, the underlying causes of hard issues are the soft, or the human issues. These are less tangible and include attitudes, opinions, mindsets, self-image, self-esteem values, beliefs and feelings about how the world is organized and people’s place in it.
A team member’s performance is directly related to their state of mind – a soft issue. Performance, which can be measured, is a hard issue. The traditional dentist refers to the former as “touchy-feely,” and tends to think hard issues are more important than soft issues; i.e., if you ignore the soft issues, they will go away.
According to John F. Welch, Jr., Chairman and CEO of General Electric, “America has spent the majority of its time working on fixing the hardware of American business. The Japanese, on the other hand, have the software; the culture which ties productivity to the human spirit which has practically no limits.”
The software of our dental offices – i.e., the culture that drives them – is where private dentistry will flourish; this versus the managed care, PPO organizations, which will constantly focus on the hard issues because their profit margin doesn’t allow anything else.
The challenge facing the leaders of private dental organizations in the 21st century will be how to get back to the roots of ultimate personal care with a spirit and fire that transforms team members into leaders, or stakeholders, who have a personal stake in the outcome of the business enterprise.
Lee Iacocca, former Chair of Chrysler Corporation wrote: “Every day in America, 242 million people wake up, and if everyone would say when he or she gets up that he or she is going to do some classy, quality thing today that he or she didn’t do yesterday, we’d be world beaters. Unfortunately, most people swing out of bed, yawn and figure, ‘Oh hell, I’ve got to make it through another day of drudgery.’ Their attitude is that they are going to do what they are told and not one thing more.” The former automaker added, “Quality, after all, is affected by something as basic as a person’s sense of values – if a person is going to do a good job, he or she has to like coming to work, he or she has to say, ‘I’m going to help produce something great today.’”
In a private dental office, each team member must be engaged in making something great happen every day. The dentist, as the titular office leader, has a vested interest in empowering this to happen.
What Does Attitude Have To Do With It?
Dental office leaders need to understand the 80/20 rule, which tells us that with any new idea – i.e., the intraoral camera or not accepting insurance assignment – people’s reaction will follow Pareto’s Principle: Approximately 20% will be open to it and see value in it; the other 80% will resist the change no matter how much sense it makes. The difference between these two groups is attitude, a soft issue. In an 18-year study of outstanding performance organizations, people’s attitudes were validated as the dominant factor separating high performance creative thinkers from reactive no-change thinkers.
Characteristics of Reactive Thinkers
The 80% we have been discussing share the following behaviors, and the dental office leader can begin to plan positive change with a basic recognition of them. Reactive thinkers:
1. Are resistant to change.
2. See reasons they cannot do things.
3. Focus on finding problems to fix.
4. Avoid blame or responsibility.
5. Tend to be poor listeners.
6. Are devastated by failure.
7. Have low self-esteem.
8. Do things right.
Characteristics of Creative Thinkers
Creative thinkers, the “20%”, share the following characteristics. They:
1. Are open to change.
2. Are “can-do” oriented.
3. Take responsibility for their actions.
4. Are good listeners.
5. Learn and grow from their mistakes.
6. Have high self-esteem.
7. Do the right things.
The new dental leader’s job is to bring out the best in people. Since attitude is so critical for the practice’s success, it is essential for dentists to understand what keeps their team members from choosing an attitude which is best for the practice. Most all the evidence now focuses on the individual’s self-image or self- esteem as the key factor in forming attitudes. How we perceive ourselves, and how we believe others perceive us, defines our self image.
What Can the New Dental Leader Do?
The new dental leader must first realize that 80% of the team has been raised to focus on what is wrong with them and only 20% of them were praised for what they did right. The 80% generally have negative self-images and invest large sums of energy trying to keep others from seeing the weaknesses they perceive in themselves. Help these people to see small success in their days and praise them. Nothing builds self-esteem faster than being successful. New dental leaders and team members will acknowledge that the practice’s success in the current environment of rapid change depends more on mutually developing each other’s self-esteem than on developing their clinical skills.
Secondly, the new leader must become conversant with the components of personal and organizational effectiveness. This is much more than knowing that the schedule is filled, that recall is being worked, and financial arrangements are being made. These components include personal empowerment, quality consciousness, clear purpose of the office, inspiring vision, and alignment of the team. In other words, the successful new dental leader must face the real issue of managing the collective mindset, or attitude, of the team, which radically affects the practice’s profitability. Improvements in practice productivity, increased levels of case acceptance, enhanced levels of personal service, increased profitability – hard issues – are the result of how well the new leader manages soft people issues.
It is helpful to know that people with low self-esteem focus on what is not working while those with high self-esteem focus on what is right and how to improve it. This is called “shifting focus.” Dental practices soar when a majority of the team shifts from a problem focus to a solution focus.
A large metropolitan practice had experienced a long list of frustrating turndowns on their treatment recommendations from a major state dental insurance company. The team felt put on the defensive by the insurance company’s negative communications to their patients about those recommendations. The doctor slowly realized that if something did not change, patient care would suffer, and that profitability ultimately would be determined by the insurance company despite all his good clinical skills. The doctor canceled days of patient-scheduled time and invested heavily in communicating what he thought a private office should feel like to his team. They role-played the conversations with patients that they felt would help them see value instead of focus on cost only, which was the insurance company’s orientation.
The training gave the team more confidence and their focus changed from being worried about saving their jobs if the practice declined insurance assignment to creating a solution for the patient so they could choose the dentistry they needed without the insurance company’s interference. This led to a high level of team commitment, passion for the cause of private dentistry and, ultimately to retaining more patients than they ever imagined possible. Not one team member lost their job.
The doctor and team focused on where they wanted to go instead of the problems associated with where they were when they began. This doctor discovered what happens when most of the team shifted their focus to a “can-do” attitude from a “can’t get there from here” attitude. Consider the power of a 100 watt light bulb. It can illuminate a hallway or light up a back yard. If the same amount of energy is focused into a laser beam, it can cut through steel. Likewise, focusing the team’s energy in the direction that you want to go gives it power.
Whose Perspective Counts?
The traditional old-style dentist responds to resistance from the staff by trying to convince them of the importance of achieving his objective. Many doctors can’t understand why their people are at all resistant. This is mostly due to the fact that most people in leadership roles don’t see the world in the way most reactive thinkers do (the 80%ers). Leaders tend to think like the creative leader, or the 20%ers. Remember that 80% of people are conditioned to focus on what is wrong and how a change may hurt them instead of the opportunity it might provide.
Asking Versus Telling
By asking their team members questions instead of telling them what to do, the team members discover for themselves what is important for them in doing what is necessary for the practice. This discovery process improves their self-esteem, self-confidence and empowers them. Asking questions sends a subtle message that says, “I care about what you think. Your opinion counts.”
In working with dental teams and asking them to clarify what they want more of from leadership so they can do a better job, money is seldom mentioned. In those instances where money is the issue, it takes some probing to discover what is meant. Usually the issue is, “I need more money to put up with this B.S.” This translates into being unappreciated and excluded, which is the result of not being asked. The real experts on the dental office, those who can solve most all its problems, are its own team.
Kahlil Gibran, (1883-1931), Lebanese Poet and Painter, had it right when he said: “The teacher, if indeed wise, does not bid you to enter the house of their wisdom, but leads you to the threshold of your own mind.”
The new leader knows that asking good questions is the key to focusing his or her people on the subject at hand. Good questions should create the following responses as the team develops its positive modus operandi.
1. Get people to think.
2. Empower people by allowing them to discover their own answers and take ownership of the results.
3. Develop people who feel fulfilled, satisfied, and valued.
4. Build positive attitudes and self-esteem in team members.
Have you ever used questions that create the effect opposite from empowering the team? Have you, for example, ever heard yourself say (or think) any of the following:
1. Why are you behind schedule?
2. What’s the problem with the recall system?
3. What’s your problem?
4. Why did you do that?
5. Who made that decision?
6. Don’t you know better than that?
Questions like these destroy self-esteem, make people feel small and unimportant, and reduce energy levels. They breed a cynical attitude.
In their place, questions such as the following begin to develop the desired positive mindset in the entire team, starting with and continuing to include the dental office leader or leaders.
1. How do you feel the recall system is performing?
2. What have you accomplished so far on your chart review that you are most pleased with?
3. What is there about the accomplishment that you most appreciate?
4. What else?
5. What are your specific objectives in extending credit to our patients?
6. Which of these objectives do you think will be the easiest to attain? The most difficult?
These questions tend to focus on what is already working, which is energizing and supportive. They also focus on benefits, which is why the benefit is important.
What Does A Good Question Look Like?
1. A good question is open-ended. Closed-ended questions are answered with “yes” or “no” and tend to discourage people from thinking. They encourage them to give only limited information.
2. Good questions will start with “what” or “how,” not “why.” “Why” questions generate instant defensiveness because they carry a judgment. “What” or “how” encourages openness and lowers defensiveness.
3. New-type leaders will ask questions not only so they can hear the answers but also so the person answering can hear his or her own answers, thereby gaining clarity.
4. Good questions will be “you” focused. They focus on the person answering. They ask, “What do you think we should do?” “What is your opinion?” “How do you feel about doing it this way?” “What was significant about that to you?” Notice there are no wrong answers to these questions because the answers are true for whoever answers them.
5. Timing is critical. The best time to ask good questions is when things are going well. Ask questions like:
a. What are you doing with the doctor’s schedule that has allowed our productivity to increase so much?
b. What are you doing differently to cause that to happen?
c. What are you most pleased with personally about what you have been able to accomplish with the accounts receivable project?
d. What have you done to contribute to the team’s success that most pleased you?
How to Structure Great Questions
Finding the right questions is key to discovering answers that will move the practice in the direction you desire. Among them you might consider:
1. What is already working?
2. What makes it work?
3. What is the objective?
4. What are the benefits of achieving this objective?
5. What can you do to move closer to the objective?
The Ultimate Test of the New Dentist Leader
Performance reviews usually are the most stress-producing exercises for both the doctor and team member. Why not change that by training the team to expect more from their job description than just what is on their list of duties. Get them to think, and give them credit for thinking by asking them to come to their next review with answers to some of the following questions:
1. Please prepare a one-page review of how you feel you have done in comparison to your annual plan. What do you consider the most important achievement in your area?
2. Please prepare a one-page or shorter statement of your personal management philosophy. Describe your personal plans for continuing education and development for the coming year.
3. Please think of ways for us to approach our accountability for the future for the practice and our joint accountability for your future in the practice. What kind of changes will be required by the growth picture we are plotting?
4. Prepare to discuss your thoughts on our competition, where we need to respond to it, and what our response should be. Please think about the following:
a. Who is gaining ground on us?
b. How do various competitors surpass us in service, marketing capability, and pricing?
1. Would you be willing to share your philosophy of management with our team?
2. What are a few of the things you expect most, and need most, from the doctor?
3. Who are you? How do you see yourself personally, professionally, and organizationally?
4. If you were in the doctor’s shoes, what key area or matter would you focus on?
5. What significant areas are there in the practice where you feel you can make a contribution but feel that you cannot get a hearing?
6. Do you have any feelings of failure in any particular area?
7. What two things should we work on toward being a great practice?
8. What will you do in the coming year to develop our three highest potential people and who are they?
Critical Factors to Becoming a New Leader
New leaders are knowledgeable about the following:
1. The most important factor in a private practice’s success is its people.
2. The leader’s behavior highly impacts the team. Talking doesn’t count.
3. People resist being told what to do, but they readily commit to making their own ideas work.
4. To the extent people feel cared for, they will go to extremes to help those who help them.
In the future when there is even more polarization between private dentistry and the PPO, insurance-driven practices, those practices with the new leader mindset will prosper beyond their expectations.
John Naisbitt, in his book Megatrends 2000 sums it up best. “During the last few years,” he writes, “we have witnessed the beginning of the transformation of the U.S. corporation. The shift is from managers who traditionally were supposed to have all the answers and tell everyone what to do, to managers whose role it is to create a nourishing environment for personal growth. Increasingly, we will think of managers as teachers, mentors, and developers of human potential. The challenge will be to retrain managers, not workers, for the reinvented, information-age corporation.”
The new dental leader will increasingly be tested, not by his or her dental skills, but by how he or she views and values the soft, or human, issues of the practice. In a full employment economy, where every team member is virtually a volunteer, the challenge is how to keep them volunteering to show up.